The Power Surge

My mother-in-law calls hot flashes “power surges,” and until I had them myself, I thought she might have been exaggerating.

Uh, no... she was absolutely NOT exaggerating. When I had them frequently (about 10 a day and 2 at night), it felt like I could power a small city. NO ONE CAN PREPARE YOU FOR THAT HEAT!

I am sure many of you have seen this gif… but like, really… 🔥🔥🔥

So, perhaps needless to say, hot flashes and night sweats can be debilitating for many women. They can interfere with sleep, make it harder to concentrate, affect our mood and energy levels, and cause us more stress, which ultimately leads to a poor quality of life—professionally, socially, and in our family lives.

Hot flashes are attributed to hormone fluctuations and can also be impacted by the inflammation and nervous system dysregulation that can occur during perimenopause. 

While the severity and frequency of hot flashes can vary, even in the same woman, according to the National Institutes of Health (NIH), most (up to 80%) of women will have some hot flashes or night sweats as they go through perimenopause, and about 10% of women will have more than seven hot flashes a day.

While hormone therapy is a very effective option for reducing hot flashes, it is not right for all women.

So, what non-hormone therapy options have been shown to help relieve hot flashes?

• Neurokinin Receptor Antagonists

Fezolinetant (Veozah): FDA-approved in 2023, this non-hormonal drug significantly reduces moderate to severe hot flashes and seems to be well tolerated.

Elinzanetant (still in clinical trials): This investigational drug, tested in large phase 3 trials (Oasis 1 and 2), rapidly reduced both the frequency and severity of hot flashes, with improvements seen within the first week. It also improved sleep and quality of life, with benefits sustained for at least six months.

• Antidepressants

SSRIs/SNRIs: Medications like paroxetine (paxil), escitalopram (Lexapro), venlafaxine (Effexor), etc., have shown mild to moderate effectiveness in reducing hot flashes, with reductions ranging from 24% to 69% in clinical trials. These are especially useful for women who also experience mood symptoms.

• Other Medications

Oxybutynin (Oxytrol): Evidence from randomized controlled trials supports its effectiveness in reducing hot flashes. Oxybutynin is not approved by the FDA for this indication, however, some practitioners will prescribe it off-label.

Clonidine: An alpha-adrenergic agonist, clonidine can help, but may have side effects like sleep difficulties.

• Lifestyle and Behavioral Interventions

Keep a journal to record where you were, what you were wearing, what you ate, and how you felt before you had a hot flash (e.g., stressed) to identify trends and triggers. 

Nutrition and Habits:

1. For some, triggers such as spicy foods, caffeine, and alcohol can worsen hot flashes.

2. Omega-3 Fatty Acids may reduce the frequency (if not severity) of hot flashes.

3. Vitamin D supplementation may help with hot flashes (low vitamin D levels are associated with hot flashes).

4. Avoid large meals and eating close to bedtime to reduce night sweats.

5. Try to maintain a healthy weight; losing excess weight may decrease the frequency and severity of hot flashes.

6. Smoking can worsen hot flashes and overall health.

Physical Activity

1. Aerobic Exercise: Activities like brisk walking, jogging, cycling, swimming, and dancing have been shown to decrease hot flashes. Studies indicate that moderate-intensity aerobic exercise performed at least three times a week for 30–45 minutes can reduce hot flash frequency by up to 60% in some women.

2. Resistance Training: Strength training with weights, resistance bands, or bodyweight exercises (such as squats and push-ups) performed two to three times per week has also been shown to significantly decrease the frequency and severity of moderate to severe hot flashes.

3. Yoga and Flexibility Exercises: While not as robustly studied as aerobic or resistance training, yoga and similar activities may help by reducing stress and improving overall well-being.

Mind-Body Practices

1. Cognitive Behavioral Therapy (CBT) can reduce the distress and daily interference caused by hot flashes (it does not always reduce their frequency).

2. Clinical hypnosis has shown significant reductions in both frequency and severity of hot flashes, as well as improvements in mood and sleep.

3. Mindfulness meditation and paced breathing may help some women cope with hot flashes.

Herbal and Dietary Supplements

Some women try black cohosh, red clover, soy isoflavones, and ginseng, but clinical evidence for their effectiveness is limited and mixed.

A recent client had some success with Relizen (Swedish Flower Pollen Extract).

What worked for me? Practicing box-breathing several times a day (with and without hot flashes). Eventually, when I'd feel a hot flash come on, I could box breathe my way through... the frequency and severity of my INCESSANT hot flashes decreased dramatically.